Lymphatic diathesis

Description:

imfatiko-hypoplastic diathesis (LGD) - the anomaly of the constitution which is characterized by a generalized hyperplasia of the central and peripheral lymphatic bodies (a thymus gland, lymph nodes, a spleen), a hypoplasia of a number of internals (heart, kidneys), a hypocrinism (adrenal glands, gonads, a thyroid gland, gipotalamo-pituitary system), lability of water and electrolytic exchange, disturbance of metabolism of lipids and carbohydrates in combination with immunological dysfunctions.

Against the background of LGD it is heavy and long acute respiratory diseases, intestinal infections, pyoinflammatory processes proceed.

The considerable number of cases of a syndrome of sudden death is connected with the timiko-lymphatic states close on an etiopathogenesis to LGD.

When performing vaccination children with LGD and a timomegaliya quite often have heavy complications. Existence at the child of LGD is considered as risk factor of developing of bronchial asthma, food and medicamentous allergy. A considerable part of the contingent of children with recurrent respiratory diseases is made by children with LGD. Prevalence of this anomaly of the constitution constantly increases. At the beginning of the last century of LGD occurred at 3,2-6% of children, and presently this form of diathesis is diagnosed for 10-20% of children of the industrial zone. The tendency to manifestation of clinical symptomatology of LGD in the first years of life is expressed, it is frequent at newborns and even babies.
At the same time, quality of diagnosis and treatment of diseases against the background of this anomaly of the constitution suffers. LGD is diagnosed practically only for children of chest age at the expressed paratrofiya or identification of a timomegaliya on the roentgenogram of bodies of a thorax. Similar practice not only lead to hypodiagnosis of diathesis, but also reduces efficiency of treatment-and-reabilitation actions.

Symptoms of Lymphatic diathesis:

Clinical diagnosis of LGD is based on identification of the characteristic symptom complex including a number of syndromes:
1. Limfoproliferativny syndrome:
a) increase in all groups of peripheral lymph nodes, even out of infectious diseases;
b) a hyperplasia of a pharyngeal lymphatic ring - a hypertrophy of almonds, adenoid vegetations, a hypertrophy of lymphatic fabric on a back wall of a throat, increase in fungoid nipples of language;
c) radiological the revealed tamomegaliya at overwhelming
most of children.

2. Dizontogenetichesky syndrome:
a) existence of three and more stigmata of a dizembriogenez or one rough anomaly of development (hernia, syndactylia, congenital dislocation of a hip, etc.).
At limfatiko-hypoplastic diathesis inborn heart diseases and an urinary system often meet;
b) the burdened obstetric anamnesis of mother - a serious genital and extragenital illness of pregnant women, an adverse effect on a fruit during the antenatal period (medicamentous influence, group or Rh incompatibility of mother and child.)
Risk factor of formation of LGD is artificial feeding.

3. Syndrome of sympathoadrenal and glucocorticoid insufficiency:
a) tendency to arterial hypotonia;
b) lability of a cordial rhythm, possible kollaptoidny states;
c) "marble" drawing cooks, hyperhidrosis and cold snap of distal sites of extremities.

4. Endokrinopatichesky syndrome:
a) a paratrofiya with an excess zhirootdeleniye in hips
b) signs of a hypoplasia of outside and internal generative organs: phymosis, cryptorchism, hypoplasia of a uterus, vagina.
Revealing the specified syndromes, it is necessary to pay attention to constitutional features of children with LGD: hypersthenic type of addition with a wide rough bone skeleton, a wide thorax with a narrow upper aperture of a thorax. Extremities are usually long, shins are longer than hips, and forearms are longer than shoulders.

Classical phenotype of the child with LGD (M. S. Maslov, 1952)
The specified clinical manifestations are most brightly expressed at children of early age.

At diagnosis of LGD at newborns and babies lean on the following symptoms:
1. Excess body weight at the birth.
2. Clinical manifestations of a paratrofiya, tendency to bystry set and loss of weight.
3. Pallor and a marmorestsention of integuments at concern, the developed venous network on the front surface of a thorax.
4. Easily arising perioral and periorbital cyanosis, even at an insignificant exercise stress (for lack of organic lesions of cardiovascular system).
5. The inborn stridor which sometimes is combined with narrowness of the nasal courses, periodically arising attacks of the koklyusheobrazny cough amplifying in horizontal position.
6. Vegetative lability - the increased perspiration, inexplicable long subfebrile condition, sometimes kollaptoidny conditions, tranzitorny disturbances of a cordial rhythm, vomiting.
Considering small informational content and insufficient specificity of the given symptom complex for diagnosis of LGD at babies, at this age, the great value is attached to identification of increase in a thymus (timomegaliya).

Clinically the timomegeliya can be suspected if at silent percussion expansion of a zone of a vascular bundle з the region of P-Sh of a mezhreberya more than on 2 cm comes to light at vertical position of the patient.

At a considerable hyperplasia of a thymus gland he sometimes manages to be propalpirovat (T. V. Matkovskaya, 1985) during crying in a yagulyarny pole at the thrown-back child's head.

It is necessary to remember that, clinical ways of definition of a timomegaliya have approximate, approximate character.

Reasons of Lymphatic diathesis:

In spite of the fact that LGD problem always remained in the center of attention of pediatricians, yet the uniform point of view on an etiology and a pathogeny of this anomaly of the constitution still is not developed. M. S. Maslov claimed "... limfatiko-hypoplastic anomaly of the constitution is in the prevailing number of cases inborn, hereditary". His contemporary S.S.Khalatov considered that on formation of diathesis decisive impact is exerted by character of food. According to M. V. Chernorutsky, the lymphatic constitution "... is not inborn, and forms within the first 3 years of life, the hyperplasia of an adenoid tissue is considered by it as compensatory reaction.

Now the evidence of genetic determinancy of LGD is obtained. It is established that LGD - an immunopatiya with the polygenic nature of inheritance. This concept is confirmed by existence at children with LGD of the increased occurrence of antigens HLA BI5, BI8, V27 that indicates genetic uniformity of this contingent of persons (Yu.S.Sapa 1992). A marker of LGD is also A(2) blood group.

Besides, the important role of adverse factors of antenatal and post-natal ontogenesis in formation of LGD is confirmed by the majority of researches. Children with LGD are born, generally from adversely proceeding pregnancy - gestoses I and P half, a nephropathy, infectious diseases in the period of a gestation. Quite often during pregnancy mother is influenced by adverse environmental factors - teratogenic substances, physical and chemical agents of UVCh, ultrasound, dyes, medicines, etc. High risk of development of LGD in children of elderly parents. At LGD markers of the broken pre-natal development - increase in amount of inborn defects, small anomalies of development (so-called stigmata of a dizembriogenez) come to light.

An essential role in an etiopathogenesis is played by patrimonial traumatization of a brain, especially its median structures. At timiko-lymphatic states deep damages of hypothalamic area which result not only in secondary adrenal insufficiency are noted, but also cause serious neurologic violations in the form of epileptiform, gidrotsefalny and convulsive a syndrome.
Can lead both exogenous, and internal causes or their combination to the formation of LGD (which is clinically shown the lymphatism phenomena).

Treatment of Lymphatic diathesis:

The tempering procedures, physical therapy. Vitamins A, groups B, C, the alternating courses of adaptogens - Glycyrramum, Dibazolum, methacil, pentoxyl, an orotat of potassium.

Prevention. A balanced diet of pregnant women and the correct feeding of the child according to age. Observance of a day regimen, walk, hardening, massage and gymnastics. Constant use of plants-adap-togenov (элеутерококк, etc.) in combination with vitamins separate courses on 2 weeks.